Neurofeedback training in ADHD children

A study using neurofeedback to control ADHD symptoms was published in the journal Behavioral and Brain Functions (2007 Jul 26;3(1):35, Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD). ) The researchers compared a group therapy program to a neurofeedback regimen.

Neurofeedback (“NF”) is a form of biofeedback in which only brain wave activity is monitored and regulated through sensors, a computer, and EEG (electroencephalogram). This is opposed to general biofeedback which may monitor and attempt to regulate EKG (electrocardiogram), respiration, galvanic skin response, etc.

Critics of clinical NF maintain that its primary benefit of increased concentration is seldom transferred to environments outside of the clinic. NF clients do well in the clinic, but frequently cannot generalize the concentration techniques to the classroom or workplace where they do not have access to the clinician or NF equipment.

The researchers wanted to see if slow cortical potentials (“SCP”) would improve attention in ADHD children. SCP is a term use to describe synchronous firing of neurons (brain cells) that functionally depict the brain’s attention regulation mechanism in cortical networks where it is posited that attention is regulated. The researchers desired to see if SCP could be regulated (thus regulating attention) using NF. It has been demonstrated in the past that regulation of SCP has helped epileptics control seizures. Theoretically, if one learns to self-regulate SCP, one could redistribute the brain’s attentional resources.

Results? The researchers used parents’ and teachers’ ratings to assess results. According to the rating scales, the children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. As critics have maintained for years, only about half of the NF group could apply or transfer their NF training outside of the clinic.

Here’s a Zen phrase highly related to this research: “Don’t Mistake the Finger Pointing at the Moon for the Moon.” If you stare at the finger, you miss the heavenly glory. This is also similar to phrases in the Indian Upanishads.

So, let’s examine a few problems of this research and its results. First, the general consideration that ADHD is a brain based neurological disorder that can be treated by just treating the brain is facile. Researchers and clinicians often focus solely on the NF technique and not the child. The child brings to the table an assortment of skills, strengths, weaknesses, and predilections. Furthermore, the child exists in the context of family, friends, school, etc. which directly affect/influence his behavior. In light of this, one cannot simply treat a portion of the brain and expect results to transfer to other aspects of the child’s environment.

Simply put, NF is instruction. It is a teaching technique. Thus, if transfer is minimal or nonexistent, the instructional method is poor. This is because NF is done in isolation of the child’s total context. Unfortunately, this is the same predicament that plagues pharmacological intervention. Learning difficulties like ADHD are seldom, if ever, the sole result of a brain based disorder. They exist in context and must be treated within context if a treatment method is to be efficacious.

The fact that we have labeled ADHD a neurological disorder (even without any associated pathology) has limited our perspective on its treatment and intervention. It will likely be years before the perspective changes.